Recently, I was asked to speak about innovations in inpatient medical education for leaders in general internal medicine. Knowing that I would be last in a distinguished lineup of speakers and that my charge was to discuss novel ways to teach in the inpatient setting, I thought it would be important to review how its been done for a long time — so long that it is embodied in one of my favorite fairy tales…
You see, Cinderella dreamed of one day becoming the best clinical educator in the academic kingdom. Unfortunately, her evil stepmom “Mrs. Dean” scoffed at Cinderella and said “teaching does not pay…look at your hard working and loyal stepbrothers….“Bill” has been our primary breadwinner due to his high volume of Patient Care and “Grant” –yes, while its feast or famine with him, just got a big payout for his Clinical Research. Teaching? That’s no way to make a living. Go work work for them until you figure you what you want to do.”
So Cinderella toiled away…until one day, she met the Godmother of a grateful patient “Mrs. Fairy” who donated a small sum money to improve inpatient teaching…and with this Cinderella was able to transform herself into one of the leading teachers of the new curriculum (she was also able to get a raise to update her wardrobe!). She quickly became a hit among all the medical students and residents who were truly “charmed”. Then one day, at the stroke of midnight, Cinderella’s protected time ran out…and all of her work went up in smoke as she was forced back to her life of hardship seeing patients and doing research. The students and residents were distraught at the thought of losing their most prized teacher and searched the academic complex for her –they were so moved they wanted to award her the precious “Glass Slipper” teaching award, which not only is bestowed with honor, but also a promotion to become a tenured educator in the academic kingdom. And she lived happily ever after…
While you may think that this is the stuff of fairy tales (especially happily ever after), we all have Cinderellas at our institutions. And those Cinderellas want to teach, but they struggle not only with funding, but also the realities of today’s inpatient environment. So, what are these Cinderellas to do? Well, there are few of the ways to ensure that clinical teaching is rewarded – and possible resolutions for the New Year for medical educators.
- Focus on a gap that needs to be filled: Protected time is most likely be awarded to someone who is filling a need – think new curriculum that is mandated by LCME/ACGME or other alphabet soup organizational body. What is the specific need that you can fill with teaching? Often this may require thinking about a topic that may not exactly match your initial interest, but it is more likely to lead to funding for your teaching.
- Learn new teaching methods: Teaching methods for today’s wards are not well developed in the land of an organized chaos. By incorporating a new platform for teaching (think case blogs, video reflection, standardized patients, or a host of other ideas), you can breathe new life into an old topic. For example, using simulation to teach end of life discussion, or using blogs to teach about professionalism, can result in a novel curricular program that not only engage next generation learners, but also gains attention of leaders in medical education.
- Document the effectiveness of the teaching – it is only through methodological evaluation that one can document that teaching translates into practice. By showing that teaching can be linked to improvements in knowledge, attitudes, or practice, it is more likely that someone (maybe a fairy) will finance this teaching as critical to the mission of the hospital. Think about procedural training that shows reduction in central lines.
- Work with a mentor – Just like ‘big research’, mentorship is still important although not always emphasized. To be honest, mentors can serve to mobilize resources or promote your work with senior leaders.
However, regardless of these strategies, funding for teaching requires institutional leadership to recognize that the academic mission of teaching hospitals is still ‘to teach’. Of course, this mission is sometimes lost in the chaos of teaching hospitals surviving budget crisis in an increasingly competitive environment. So during this holiday season as everyone is reminded of the time of giving, now is a great time to remind the fiscally minded Mr. Scrooge in your C-suite that the greatest gift they can give is enabling a teacher to teach the future doctors of our nation.
–Vineet Arora MD